Kim A Callaway | Edwardsville, IL • PECOS Search

Kim A Callaway

Counselor

Behavioral Health & Social Service Providers

40b Edwardsville Prof Park, Edwardsville, IL 62025-3602

PECOS Enrollment

Based on the most recent information from CMS, provider Kim A Callaway does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1376825950
Provider Type
Individual
Full Name
Callaway, Kim A
Credential
LCPC

Gender
Female
Sole Proprietor
No
Enumeration Date
9/9/2011
Last Updated
9/9/2011

Contact Information

Practice Location

40b Edwardsville Prof Park, Edwardsville, IL 62025-3602

(618) 731-4178

Mailing Location

PO Box 101, Edwardsville, IL 62025-0101

(618) 731-4178

Provider Taxonomies

Code	Description	License
Code 101YP2500X Primary	Description Counselor Behavioral Health & Social Service Providers	License 180.007949 Illinois